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5737 Swope Parkway, Kansas City, Missouri 64130
www.bccgkc.org

Membership Application

Please do not include any special character. like (,.)

Type of Business

5511
7353
7231
7929
6282
8621
7011
6411
8111
8742
3577
2759
8743
8611
2741
6351
5812
5131
1799
5088

Annual Gross Income

Certifications

Investment Schedule (Note: Membership dues are based on the calendar year)

50
100
300
300
400
500
600
850
Corporate
2,550
5,000
7,500

BCCGKC Committee(s) Please select the committee(s) in which you would like to serve on.

Method of payment

I hereby certify that the information contained herein is true and accurate to the best of my knowledge.